17% increase in prostate cancer death predicted by NCI for 2010

ZERO - The Project to End Prostate Cancer has launched a campaign against the US Preventive Services Task Force and the ACS because of their stance on prostate cancer screening. I spoke to Skip Lockwood, the CEO at ZERO, at the AUA so I wasn't surprised to see this announcement. In the last five years there has been an increase in the number of AS patients and a decrease in the number of men being screened has also been observed.

I personally do not align myself with the conclusions drawn, at least not completely. It makes sense that if you are going to decrease screening, and tell more men to delay or not treat their prostate cancer, that the death rate will go up. One has to balance this logic against men who have indeed been over treated. Certainly anyone who loses their life when it could have been prevented won't care too much about avoiding side effects. But I think that it is way too early to attribute a 17% increase in the mortality rate solely to changes in whether to treat or not and screening. But one will have to ask, what has changed in the last 15 years in treating prostate cancer that the death rate is expected to climb for the 5th year in a row, with the largest annual increase in 15 years.

Here is what ZERO is saying...

www.zerocancer.org/site/News2?page=NewsArticle&id=11611&news_iv_ctrl=1001

Text below...

Prostate Cancer Deaths Up 17 Percent
Testing debate to blame as mortality hits 10-year high
by Ashley Nagaoka | ZERO - The Project to End Prostate Cancer | 06.15.2010

Prostate cancer deaths are expected to jump 17 percent this year, according to estimates based on National Cancer Institute data.

The alarming 2010 statistics, released just prior to Father’s Day, has ZERO – The Project to End Prostate Cancer urging families to encourage Dad to get tested for the disease this Father's Day because prostate cancer is the second leading cancer among Amercan men.

“If prostate cancer is diagnosed before it spreads, a patient has a 99 percent survival rate for five years,” ZERO Chief Operating Officer Jamie Bearse said.

“You can only diagnose cancer early through annual testing. This is the sad result of the PSA controversy created by the American Cancer Society and the U.S. Preventative Services Task Force. We need a better biomarker for the disease to distinguish slow growing tumors from deadly ones but in the meantime, we need to keep testing.”

The new numbers predict a 17 percent jump in deaths and a more than 13 percent rise in diagnosed cases this year as compared to 2009. It marks the greatest percentage increase since the mid-1990s.


Source: The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI)

“The American Cancer Society claims it’s the official sponsor of birthdays, but it is condemning more men to their funerals because of its stance against the PSA test,” Bearse added.

“It’s not too late, however, and we can change these predictions. Encourage your Dad to get tested and give him the gift of life on this Father’s Day.”

Copyright ZERO - The Project to End Prostate Cancer 2010


Tony

Tony, thanks for sharing.  However I am surprised and disappointed that you would lump men choosing AS in with lack of screening or connect AS with these articles. There was no mention of AS (that I could find) in either article you posted,  And, as you well know, if AS patients are properly chosen and properly monitored there is no difference in efectiveness of treatment if one is needed.

I guess what I'm saying is that you threw the baby out with the bath water by dumping on AS at the same time you dumped on lack of screening.  I am a big fan of routine testing AND a big fan of AS and do not believe they are mutually exclusive.

Tudpock (Jim)

This just doesn't make any sense. We have an increase in screening and we have an increase in treatment and still get a 17% increase in deaths reguardless of all the advances in treatments. This sound like an agenda driven statistic without a lot of reality behind it.
The report cleary state than the 17% increase will happen this year. This is way too soon to conclude that the increase in AS or recent drop in screening has any impact.
If it indicates anything it indicates that the treatment we are getting are not effective.
JT

If this stat of increased deaths due to PC comes to bear, its a sad testimony and I would agree a lot with JohnT's opinion. Kind of doesn't make sense on the surface.

David in SC

I would not solely attribute a 17% increase to just social economics, but I would not be surprised to see that the bad economy has led to less people being treated when they should have been.

Tony

Tony, your statement:  "...so I wasn't surprised to see this announcement. In the last five years there has been an increase in the number of AS patients...".  There has also been a great increase in the number of men selecting da vinci robotic surgery rather than open....do you also think that is a contributor to this statistical prediction?  C'mon...now you're using "predictions" to bash a treatment choice?  Your conclusions are not sound, IMHO, and do a disservice to men who choose or may consider choosing AS as their option.

You also say, "There is very little information that indicates that AS does not increase mortality though I acknowledge there is some data that says delayed therapy is safer than first thought."  As discussed in another thread, Johns Hopkins says this regarding mortality of AS patients: "Of the men who have undergone surgery to treat their prostate cancer at the time the follow-up biopsy showed adverse findings, the proportion with curable disease appears to be similar to those men who would have qualified for the program but chose to undergo surgery immediately instead of expectant management. Thus, it would appear that when men are carefully selected for expectant management, the window of opportunity for cure is unlikely to close with monitoring." 

ChrisR is clearly right, in my opinion, when he states this is only a prediction anyway.  As the New Prostate Cancer InfoLink noted:

The estimated numbers of new cancer cases and deaths in the current year are model-based and may produce numbers that vary considerably from year to year. For this reason, the use of our estimates to track year-to-year changes in cancer occurrence or deaths is strongly discouraged. Incidence and mortality rates reported by the Surveillance, Epidemiology, and End Results (SEER) program and NCHS are more informative statistics to use when tracking cancer incidence and mortality trends for the US. Rates from state cancer registries are useful for tracking local trends.

Tony, the bottom line for me is that I'm certainly with you on the need for screening but I seriously object when you use questionable predictive data to bash active surveillance.

Tudpock (Jim)

I don't understand the math that shows a 17.1 % increase in deaths.   The way I read this is: 1.  Of the men diagnosed in 2009, 14.23% will die. 2.  Of the men (predicted to be) diagnosed in 2010, 14.72% will (are predicted to) die.   Isn’t that a .03% increase in the number of deaths?   Paella  

Tony, I went back and read the Trock study that you referenced.  One of the co-authors was Dr. Ballentine who heads up the AS program at Hopkins.  Shown below is verbatim from the study which anyone can read by looking at the May 31, 2010 supplement to The Journal of Urology. I don't know what else to say except that the conclusions from the study that you referenced do not support your supposition that AS is part of the cause of a predictive increase in PCa deaths.  Maybe it is and maybe it is not...just as the movement to robotic surgery from open surgery may be part of the cause.  The fact is that there is no statistical data that supports either of those conclusions and we should not pretend that data exists to substantiate our personal beliefs.

CONCLUSIONS: Men who undergo delayed RP after initial management with AS have similar pathological outcomes to those men who are candidates for AS but undergo immediate surgery when matched for Gleason score. These data suggest that active surveillance is associated with a low risk of stage progression.

 

Tudpock (Jim)

I wish I would've been tested sooner - I just git injected with Eligard on Monday and so far the cure seems worse than the PCa. Feeling very tired, weak & depressed. I was OK on the Casodex alonbe but the combination is really doing me in.

I want to exercise some but the fatigue is just over-whelming.I called the Uro office about it and he said it takes up to 7 days to feel the effects so the fatigus must be from something else.

All I've been doing is sitting around the house feeling sorry for my-self. Still have to self-cath some so don't want to leave much. Tried to go for a walk last night but was in bed by 11pm and woke up around 6:30 am but then fell back asleep until 11:30.

Should I be this tired? Don't want to hijack this thread - I can start a new one if you want - thanks!

Tony,
I reread the conculsion a couple of times. It says that a small fraction of those choosing AS will have incurable tumors, but so will men that have been treated. Klotz determined that 1.7% of those meeting the AS criteria will have non curable PC REGARDLESS of treatment. So having treatment for these rare varients will not increase your chances of a cure.
It is common sense that the rate of adverse pathology is the same for those who are treated and not treated; this is why I think it is imperitive that anyone considering AS get either a 3D Saturation Biopsy or a Color Doppler Ultrasound to reduce this risk.
This is reminder that nothing in the PC world is 100% and there are risks with and without treatments that every patient must deal with these risks. There is no treatment that has a 100% cure rate and all treatments have a 100% chance of side affects, a large percentage of which will be permenant.
JT